Abstract
BackgroundSerious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14 and 25. Once diagnosed, young peoples’ health can deteriorate, and it is therefore vital to detect this early to prevent severe outcomes including hospitalisations and deaths by suicide. The main study aim is to describe and discuss observational studies that examine signs of deterioration in young patients with SMI.MethodsA systematic review guided by the published protocol was conducted. Cumulative Index to Nursing and allied Health Literature (CINAHL), MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC) and Web of Science were searched against pre-defined criteria until 1 March 2021. Observational studies were extracted according to design, country, participant, indicator, outcome and main finding categories. Quality was assessed independently using the Newcastle Ottawa Scale (NOS).ResultsOf the 15,788 publications identified, 5 studies were included and subjected to narrative synthesis. Two indicators of mental health deterioration were identified: cognitive functioning (decline, worsening and poor school/academic performance) and expressed emotion status. Indicators revealed mixed views on predicting deterioration. Worsening cognitive functioning and expressed emotion status significantly predicted medication non-adherence and relapse respectively. However, a decline in cognitive functioning (poor academic performance) was not found to significantly correlate to deaths by suicide. Study quality was mostly poor and associations between indicators and varied outcomes were weak. The heterogeneous nature of the data made comparisons difficult and did not allow for further statistical analysis.ConclusionTo our knowledge, this is the first review of observational studies to identify indicators of deterioration in young patients with SMI. Worsening cognitive functioning and expressed emotion status could indicate non-adherence and relapse in young patients with SMI but larger sample sizes in good quality studies are needed. The dearth of observational studies means further research is required to ascertain other indicators of deterioration before serious outcomes occur.FundingThis work was supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre via an NIHR programme grant. The authors are also grateful for support from the NIHR under the Applied Health Research programme for North West London and the NIHR Imperial Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Trial registrationThis systematic review has been registered on PROSPERO (registration number: CRD42017075755).
Highlights
Serious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14 and 25
Three quarters of SMIs, including schizophrenia and bipolar disorder first develop in young people, from 14 to 25 years [1]
The nonrecognition of early signs of deterioration, absence of, or delay in accessing appropriate mental health services coupled with the reluctance for young people to disclose impromptu concerns to healthcare professionals [8], means young people are still at potential risk of deteriorating in mental state [9, 10]
Summary
Serious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14 and 25. The exact prevalence for this age group is unknown, but an estimated 0.5% of young people suffer from a psychotic disorder and 3.4% from bipolar disorder [2] This is a critical stage for young people because of the neurological, biological and cognitive changes of adolescence to young adulthood, in addition to environmental changes (e.g. major educational milestones in secondary and tertiary education, employment, increased social demands and new relationships) [3, 4]. For those receiving care for their condition, it is likely a difficult transition from children and adolescent (CAMHS) to adults’ mental health services (AMHS) [4, 5]. Outcomes can include admission to emergency care and participating in unsafe behaviours (e.g. aggression, self-harm, death by suicide)
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